Doctors slam alternative medicine proposal

Some medical groups are concerned that proposed guidelines on how Ontario doctors should approach alternative medicine may require physicians to accept and incorporate the practice.

"We believe the draft policy should be revised to sharpen its focus, and should respect the conviction of many physicians and clinical researchers, that [alternative medicine] has minimal scientific validity and that recommending it to patients achieves no clinical purpose and may be unethical," the Canadian Medical Association says in a written letter to the College of Physicians and Surgeons of Ontario (CPSO).

The Ontario college is currently taking submissions from the public and organizations about its draft policy guidelines for physicians regarding how they should handle alternative medicine.

In the proposed guidelines, the college differentiates between allopathic medicine (traditional or conventional medicine taught in medical schools) and non-allopathic therapies (complementary or alternative medicine).

The goal of the proposal "is to prevent unsafe or ineffective non-allopathic therapies from being provided by physicians, and to prohibit unprofessional or unethical physician conduct in relation to these therapies," the college said.

The guidelines, if approved, would prohibit doctors from misrepresenting the benefits of alternative medicine, the college said, but it stressed it had no intention of depriving patients of alternative medicine therapies "that are safe and effective."

Groups worry about doctors' role in proposal

However, a number of medical professional organizations feel the proposed guidelines may give alternative medicine scientific legitimacy. They also worry the proposals place an expectation on doctors to have knowledge of alternative medicine and promote its use.

"It is a matter of concern for us, that CPSO’s draft policy appears to require of physicians a high level of knowledge regarding [alternative medicine], and a high level of acceptance for its routine incorporation into practice," the CMA said.

"We find it disturbing that the college would not discourage physicians from selling products to patients, and/or entering into affiliation with an alternative clinic or therapy, particularly in light of our concern as to whether [alternative medicine] represents valid scientific medicine."

The Canadian Society of Allergy and Clinical Immunology expressed similar concerns, and said the draft policy falls "far short" of its goal to prevent unsafe or ineffective alternative therapies from being provided by physicians.

It urged the college to revise the draft and "seriously consider adopting a more appropriate evidence-based stance against the use of unproven or ineffective therapies by licensed physicians."

It said the college has suggested a false equivalence between conventional and non-conventional medical approaches, "resulting in tremendous ambiguity completely open to misinterpretation."

"We believe the standard of care in this evidence-based, scientific era should and must be high, and that the CPSO draft policy as worded would offer a disservice to both their member physicians and the public interest they are mandated to protect."

They say the draft appears to largely ignore the "potential harm to patients by promoting an unproven and likely ineffective option over an effective, scientifically established convential medical therapy."

The British Columbia Medical Association said the draft policy requires "major changes" to reflect that the "products, interventions, diagnostic techniques and assessments of alternative medicine are not generally accepted by the scientific community" and that "ethical challenges" arise when physicians form professional affiliations with alternative producers.

"Alternative medicine should never be misrepresented to the public as genuine medical therapies," it said.

Some organizations also take issue with the fact that policy refers to conventional medicine as allopathic, and alternative medicine as non-allopathic.

'Obvious distaste and disapproval'

The CMA said allopathy is a term that originated from homeopathic practice, and is often used "in a derogatory sense" and is an inaccurate way to describe modern medicine.

But the policy has also drawn criticism from organizations that support alternative medicine treatments, saying the guidelines actually give short shrift to the practice.

The National ME/FM Action Network, devoted to Chronic Fatigue Syndrome and Fibromyalgia, said the policy reveals that the CPSO has "obvious distaste and disapproval" for alternative medicine therapies and places a "chill" on the profession.

The Board of Directors of Drugless Therapy - Naturopathy (BDDT-N) said the document suggests allopathic medicine is supported by evidence and non-allopathic medicine generally is not.

"This is clearly not the case as there is documented evidence in support of many of the 'non-allopathic' therapies and at the same time there are many treatments used in 'allopathic' medicine that are not supported by evidence," it said.

However, the College of Naturopaths of Ontario said it generally supports the policy, although CPSO should consider removing "non-conventional" as a description of the practice and that it should strengthen the recommendation that physicians develop relationships with non-allopathic providers.